In a society of immediate gratification, my experiences climbed a new high May 19th. Having lived in three continents, four countries, and ten cities for significant periods of time, I frequently live in delusion that I have seen it all, experienced it all, and never cease to be surprised when I enter a new high.
High? Yes, sometimes that is how it feels.
Split second decision taking is not new to me, for better or worse, most of my decisions have been instantaneous, including the nine jobs I have worked at, including summer internships in India. Just like the decision to move from one city to another, seven times in my life (the other moves were involuntary, because my parents moved me), have been fairly instantaneous. And, my decisions have invariably been firm, and right.
Monday, May 18, 2009 shall never be forgotten. For the first time in my life I reversed a major decision in my life, and again, I have no regrets but feel an urge to share the experience here.
Emergency Euthanasia!
Does that sound strange? On introspection, it does to me. But at that time, the emotional decision appeared as logical as the other major decisions I have taken in my life.
From just before my family moved to the suburbs of Washington DC, our lives have been enriched by a bundle of joy called Chinna, Gold in Kannada (one of the 18 languages in which the Indian constitution is written, and one of 1654 languages and dialects in India). This is a term of endearment in many parts of India (though the word is different in each of the languages).
Our daughter picked this name for the new addition to our family because Chinna is Gold, and Chinna is our Golden Retriever.
About twelve years have passed. Chinna has been the best thing that happened to our family, giving immeasurable love and attention to every one who crosses his path. Dog haters and those who avoid animals have been converted beyond belief - my mother who was mad we got another dog and said she would never visit us again, every time weeps to leave Chinna behind, while she is quite ok bidding us goodbye! Many friends overcame their fear of dogs spending time with Chinna, so he has been therapeutic to one and all.
May 9, 2009
Chinna was not his usual self and since he carries a wellness plan from a national company,I called for an appointment to take him in for a check up. I could not get an appointment and was asked to just bring him in and leave him there - I refused to leave a sick dog along indefinitely as he would be stressed out. After a lot of pleading, I was given an appointment to bring him in on Saturday afternoon, which I accepted. Saturday morning they called and canceled the appointment and again said I could leave him there all day and they would check him out when ever possible. Of course I refused, and after feeding Chinna rice and yogurt for two meals, we were seeing some improvement and by evening he was as good as new. Sunday was fine, but sadly on Monday morning he was again deep in the dumps and this time I just went to the hospital and said I would take my chances without an appointment. Chinna was seen and the recommendation was that they do some laboratory work and do some 5 X-rays, as the doctor suspected his spleen was bleeding, he had cancer and could require chemotherapy. The prognosis was not good and the way it was presented, made it even more unpalatable. So I got them to do the lab. work, confirmed that the lime disease treated six weeks ago was stronger than ever before.
May 19, 2009
We were in Connecticut. Chinna had been dropped off with a cousin on the 15th, on the way to Boston for our daughter's graduation. We were now headed home and picked Chinna, who was delighted to see us all again and we headed home around 2:15 PM in a fully loaded van, where he had two seats and the legroom which had been raised with bags to provide sufficient space for his full bed. I believe he traveled in reasonable comfort. He was fine at the first pit stop, not so good at the second and the final leg of the trip he sat on the floor. When we reached home about three hours later, he could not get out of the car and had to be carried to the family room.
Half an hour later,we were at an incredible emergency room in Vienna, which works 24/7 for pets. The phenomenal staff took him in, did the ER routine and a most talented doctor saw us in about an hour with an ultrasound image confirming that Chinna's spleen was bleeding, and he had a tumor that might be malignant. She patiently explained that this is not uncommon in 12 year old Golden Retrievers, and while they would like to call families and tell them it was benign, tumors usually are malignant and no one has any idea how much it has spread until surgery. She said that we can expect at best two to six months if we did everything - operate to remove the spleen, tumor and all traces of the problems. She also explained that Chemotherapy for dogs is different from treatment for humans, as for animals they do not try to cure, but only manage the problem and reduce the pain. So the side effects would be a lot less than for humans under treatment. We could not decide, and asked her what she would do in our shoes - she was clear that she would not subject her pet to the trauma and pain, with no significant guarantee of happiness or success, so euthanasia was most appropriate. My wife left to bring the children, and I executed the papers for cremation. I also asked to see Chinna again, to bring him into the consulting room.
A picture is worth a thousand words
This is not said without reason. Once Chinna was back with me, and while he was restrained and appeared weak and wan, his smile made it very clear that he was no where near ready for euthanasia. I informed the staff and doctor that I was taking him home and we would take our chances. They were almost outraged and repeatedly said our action was against all medical advise and wisdom and suggested that at the least we leave him behind for the night so they could attempt to stabilize his condition before we take him home the next day, for euthanasia at home. He was at risk for sudden death and suffering we were warned and the wonderful doctor also wrote in the discharge papers:
It was recommended that you do not take Chinna home in his current state; however, I am hopeful that some how, he will resorb the blood he has hemorrhaged into his abdomen.
She also dispensed a Chinese herbal drug that has shown some promise in preliminary studies to stop bleeding.
Chinna returned home, had a sleepless night, threw up twice, and generally did little to bring hope to any one. Called our local Vet to schedule a home visit for Euthanasia, the earliest they could to was Wednesday morning after 9:30 AM. Spoke with the doctor and understand what this involved and how to proceed. Called for some help and dug a very deep grave in our yard, so Chinna could be buried in the surroundings he loved and had roamed about the last 11 years.
We would make a beautiful flower bed in his memory and plant bright flowers every year, so Chinna would still make the sun shine. About ten years ago, our nieces wrote and sang a song, "Chinna makes the sun shine" and that is how we remember him all the time.
Chinna makes the sun shine
May 24, 2009
We are into our 5th day, after bidding Chinna goodbye. Every one of our friends has visited us to see him, enjoy his company one last time, and to bid him good bye. Countless tears have been shed and several prayers have been offered in Chinna's behalf. He has had some bad moments, causing a lot of anxiety. But over all, he is doing well. He does look bad and dying from time to time, but then there are other times when he jumps up and charges to the front door barking when some one rings the doorbell. When we have a visitor he wishes to greet, he is looking around for a toy to carry in his mouth, as he has done all his life. From time to time, he asks to be taken out on a walk, including this morning at 6:15 AM just before my wife was driving to New York with visiting family! He barks at those who dare cross his line of vision 200 feet away behind a fence, and he barks at those who are mowing grass in our front yard. He asks for food, water, and sleeps in the sunlight as he always did.
Is there a point to all this?
Yes, now Chinna joins the ranks of those who have caused introspection, and taught me a lesson.
I agreed to euthanasia and cremation,in a matter of minutes because the learned doctor told us nothing can be done to really save Chinna, with any significant assurance of success. We could operate, treat and still lose him in 2-6 months. Not my approach to life. My philosophy is very clear, when life is not worth living, it is best not suffered. Many is the time I wished I could take the life out of an uncle who spent 7 years of his 71 years bedridden, with at least 7 months with zero movement, of even his eyes! Without speech, without any indication that he knew what was going on around him. Without the ability to even watch TV, or listen to the radio or some music. Sadly, this is not an option and I had to just watch him suffer, and his wife and children suffer at his suffering.
But, with a dog, euthanasia is an option, so we had an easy way out.
Which is what I tried explaining to the dedicated technicians at the Emergency Hospital. Euthanasia is a very easy option, every one will approve the stoic decision to put the animal out of suffering. The process is dignified, graceful and very peaceful. The animal just goes to sleep, the heart stops in seconds, and the animal does not wake up again. Sometimes, the eyes remain open, because there is no energy to close them, so I was warned to be prepared to have to physically close the eye lids.
Because, we are conditioned to have the dead lie with closed eyes - you can not have a body staring you in the eye!
We are also conditioned that it is most cruel to subject a loved one to any pain, and suffering. Do what ever you can to keep the pain out, the suffering eliminated, and it does not matter what the consequences.
Consequences? Are there any consequences? Do we know? Does any one know? We trust Doctors and medical staff, who see this happen day in and day out. They have also studied and read all the learned opinions of experts. We have family and friends who have their own experiences, which they generously share.
But does any one really know?
Exactly 8 months ago, to the day, I was beside my wife's father on his deathbed. He insisted he did not want to be in a hospital, insisted he should receive no treatment (including intravenous feeding)and he just wanted to die in his bed. At 87, we believed he had the right to choose how to die, and when to refuse treatment. He was also bleeding to death, from an abdominal aneurysm that had doubled in size over the last 5 years, since when a stent had been implanted. He had been given 48 hours, but lasted 14 days - a good part of it spent bidding goodbye to hundreds of relatives, friends, well wishers and beneficiaries of his generosity over the years. Until half an hour before he breathed his last, he was asking for juice, by opening his mouth. Until the previous day, he would shake or nod his head to answer questions on whether he would eat or drink something. Until two days before the end came, he would actually answer yes or no. Will he have liked to have put out of the suffering a few days earlier? He kept asking for euthanasia, knowing full well that was not an option. But when the end came, and he had no control over life, do we know that he really wanted to go? Or, does life instincts instinctively work overtime to keep one alive?
Do we really know?
Just now, Chinna has gone out for his second walk, with our daughter - barely 210 minutes after returning from the earlier walk with my wife. He loves the outdoors, and is all excited at hearing the word, even when we spell it out as w-a-l-k! Will he be glad to go through some suffering, so he could have one more walk? What is the break even point? How much suffering should one go through, to get one unit of something pleasurable?
Do we really know?
I believe no one really knows. Every one has theories.
Who should decide for you?
That is the main purpose of this diary. Be sure to think about this and make it clear to those around you what you would like when it is your time. No one knows when their time will come. It could be today, or in 50 years. Does any one really know? No!
Euthanasia is a decision that NEVER needs to be taken in a hurry. It is never an emergency decision. It needs to be a leisurely decision, when death is farthest from your physical state of being. In human beings, while real euthanasia is not an option, some form of it is reality. Should you be put on the plug? For how long? When should the plug be pulled? What is the criteria for intravenous feeding? For how long? Under what circumstances? At what cost? Not just money, but everything else. When should brain surgery be attempted? What risk factors are acceptable to you? Should your wishes be honored, and carried out? Or, should some one be allowed to over ride your wishes and take their own decisions? The ones closest to you may not be the best ones to carry out your wishes, as their own emotions could over ride your expressly stated decisions. Friends are sometimes better than a spouse or sibling. Children may be dependable, varies from family to family. An Attorney may be best, as they are cold, impersonal and trained to stay objective and devoid of emotions.
What ever works for you, you know best. Give it some thought, share your views with friends and family. Talk about it, so this is a well thought out decision, and every one understands the logic. Preferably keep it flexible, giving time lines for the decision process.
For example:
Do anything and everything for the first 24-120 hours
Do not do anything after the first week
In some circumstances, and health conditions, extend the duration
In others, reduce the duration
There is no global approach to this. Death is very personal, and it is best you attempt to define what your preferences are. No one knows your preferences better than you do.